The present invention generally relates to a channeled bone plate and related methods for implanting the same for use in repairing bone fractures. More specifically, the present invention relates to a bone plate including one or more channels that permit flush mounting of wires or cables around a fractured bone as part of splinting fractured sections of a broken bone.
Open reduction with internal fixation (ORIF) has long been a method for repairing severe long bone fractures in orthopedic surgery. Typically, a long intramedullary rod or bone plate is used to stabilize the fracture once it is reduced. Without proper reduction, a high percentage of fractures fail to properly heal. That is, fractured sections of the bone may not properly grow back together in proper alignment.
Temporary clamps, pins, and/or cables are typically used to achieve proper reduction and to hold two sides of a severe long bone fracture together to allow the bone plate to be implanted. The bone plate acts as a buttress or brace to hold the fractured bone in the proper orientation, which in turn encourages proper aligned healing and fusion of the fractured bone. Clamps are typically used initially to hold the fracture together. Unfortunately, clamps cannot be used alone for reduction because the shape of the clamp interferes with proper implantation of the bone plate. More specifically, the surgical opening through which an ORIF procedure is performed exposes only a small portion of the fractured bone. To hold the fractured bone in proper alignment, the clamp must cover a large portion of the exposed bone. The bone plate cannot be implanted because the clamp is in the way. Alternatively, temporary pins can be inserted away from the location where the bone plate will be implanted to provide added support in conjunction with the clamps while preventing interference with bone plate implantation. The pins may stabilize the fracture enough to remove the clamps to allow for attachment of the bone plate via a series of screws that insert into and threadingly engage the bone.
Unfortunately, the pins are not suitable for use in certain fracture patterns. For example, in periprosthetic fractures (e.g., as shown in FIG. 1) that occur around previously implanted orthopedic devices (e.g., total knee or hip replacements) require cables or wires to hold pieces of the fractured bone together. These cables or wires are typically between 1.02 millimeters (18 gauge wire) and 2.0 millimeters in diameter. Once the wires stabilize the fractured bone, a bone plate is placed on top of the cables and screwed into the bone. It is preferable that the cables or wires remain wrapped around the bone after bone plate implantation since the cables or wires aid the bone plate in bracing and supporting the fractured bone. Although, the cables or wires may be removed while the screws in the bone plate are tightened so that the bone plate more securely seats flush with the bone, otherwise the bone plate may be biased away from the bone by an approximate width of the wire or cable wrapped around fractured portions of the fractured bone. If the bone plate does not remain flush during the healing process, the bone may become misaligned and improperly heal.
Two devices are known in the prior art that facilitate bone plate implantation for purposes of setting severe long bone fractures. One prior art solution is shown in FIG. 2 and includes a buttoned bone plate 10 that couples to a fractured bone 12 through use of a button 14 that permits slidethrough mounting of a cable 16. The button 14 threadingly attaches to a top surface 18 of the buttoned bone plate 10 and contains a through-hole 20 to permit slide through engagement of the cable 16. To implant, the buttoned bone plate 10 is placed on top of the fractured bone 12 and the cable 16 is routed through the through-hole 20 and around both the buttoned bone plate 10 and the bone 12. The drawback of this device is that a gap 22 exists between the bone 12 and the cable 16 since the cable 16 wraps around both the buttoned bone plate 10 and the bone 12. The gap 22 reduces the ability of the cable 16 to snugly hold the two fragments of the bone 12 in the proper position. This may, in turn, lead to misalignment of the bone 12 and improper healing.
The other prior art solution shown in FIGS. 3 and 4 is a tunneled bone plate 24 that includes one or more tunnels 26 that permit slide-through mounting of the cables 16 to the tunneled bone plate 24, in much the same way as the button 14. The tunnels 26 extend through the width of the tunneled bone plate 24 and are generally parallel to the top surface 18. In this solution, the cable 16 routes through the width of the plate 24 via the tunnels 26 as shown in FIGS. 3 and 4, as opposed to being connected to the top surface 18 of the buttoned bone plate 10 via the button 14, as in shown in FIG. 2. Threading the cable 16 through the tunneled bone plate 24 in the manner shown generally in FIGS. 3 and 4 prevent the cable 16 from sitting flush against the fractured bone 12, thereby also creating a gap 28 between the bone 12 and the cable 16. While this gap 28 may be smaller than the gap 22 shown in FIG. 2 with respect to the buttoned bone plate 10, the gap 28 is still large enough to permit undesired relative movement of fractured sections of bone, which can lead misalignment. Thus, the buttoned bone plate 10 and the tunneled bone plate 24 are insufficient solutions to adequately maintain fractured sections of bone in preferred alignment to facilitate proper healing.
There exists, therefore, a significant need in the art for a channeled bone plate and methods for implanting the same that permits flush mounting of one or more cables or wires designed to wrap around and secure fractured sections of a bone underneath the bone plate, while simultaneously permitting the bone plate to sit flush against fractured bone sections substantially along its length, thereby substantially eliminating the undesirable gap that exists between the wrapped cables or wires and fractured bone that permits movement of relative sections of the bone fracture. The present invention fulfills these needs and provides further related advantages.